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CODE 



RULES AND REGULATIONS 



GOVERNMENT OF THOSE EMPLOYED IN THE 
CARE OF THE PATIENTS 



PENNSYLVANIA HOSPITAL 

FOR THE INSANE, 



NEAR PHILADELPHIA.. 



SECOND EDITION. 



PREPARED AND PRINTED BY AUTHORITY OF THE BOARD OF MA.NAGEKs. 



PHILADELPHIA: 

T. K. AND P. G. COLLINS, PRINTERS. 

1850. 



CONTENTS. 





PAGE 


Introductory Remarks, 


5 


Officers, 


11 


General Rules, 


13 


Duties of supervisors, 


15 


of teachers, 


16 


of attendants, 


17 


1. Intercourse with patients, 


17 


2. Supervision of patients and wards, 


19 


3. Morning duties, .... 


20 


4. Cleanliness and ventilation of wards, 


20 


5. Meals and giving food, . 


21 


6. Administration of medicine, . 


23 


7. Bathing, 


. 24 


8. Shaving, 


. 24 


9. Walking out with patients, 


25 


10. Patients at work and out-door attendants 


■ 27 


11. Reading in wards, and lecture-room enter 




tainments, 


. 27 


12. Retiring at night, .... 


. 28 


13. Seclusion of patients in their rooms, 


. 30 


14. Restraining apparatus, 


. 30 


15. Escapes, ... 


. 31 


16. Suicidal cases, 


. 32 


17. Dangerous weapons, 


. 33 


18. Prohibited articles, 


. 33 


19. Patients' clothing, .... 


. 34 


20. Visiting between wards, . 


. 35 



CONTENTS. 



21. Leave of absence, . 






35 


22. Notice to leave and discharges, 




37 


Duties of special attendants, 




39 


of watchman and watchwoman, 






40 


of seamstress, .... 






42 


of coachman, . 






43 


of carpenter, .... 






44 


of gardener, . . 






45 


of gatekeeper, .... 






46 


Admission of visitors, . 






48 


Conclusion, 






50 



INTRODUCTORY REMARKS. 



The history of the institution for which this code of 
rules and regulations has been prepared extends back to 
the year 1752, when a number of the benevolent citizens 
of Philadelphia established in that city the Pennsylvania 
Hospital, which, besides its admirable provision for the 
indigent sick, is distinguished as being the first establish- 
ment for the care and treatment of the insane, in Ame- 
rica. 

From the foundation of the institution till the first day 
of 1841, the insane were received and treated in one wing 
of the hospital in the city ; but its position in the midst 
of a flourishing metropolis, its contracted buildings, its 
limited extent of ground, its want of privacy, and, above 
all, its having no distinct medical organization for the in- 
sane department, rendered it obvious that a different 
arrangement, with a country location, would have many 
important advantages. 

Fortunately, the wise foresight of the early managers 
of the hospital had secured a number of vacant lots 
around their original structure, and the sale of these, in 
1836 and 1837, produced a fund from which a farm was 
purchased, and the buildings now known as " The Penn- 
2 



6 INTRODUCTORY REMARKS. 

sylyania Hospital for the Insane/' were erected, 
and furnished for the accommodation of patients. 

The Pennsylvania Hospital, in both its branches, is 
strictly a benevolent institution. Founded by the libe- 
rality of private citizens, its main dependence has always 
been upon the contributions of the charitable, and all its 
funds are sacredly devoted to the relief of the afflicted, 
and spreading its advantages among those who could not 
otherwise partake of them. Every increase of its re- 
sources enables it to extend its sphere of usefulness in 
the community. • 

Every one, therefore, who engages in any post connect- 
ed with this institution should feel that he is bound in 
honor to fulfil a part of this great trust, and by a faithful 
performance of duty, to aid as far as possible in carrying 
out the great objects of its benevolent founders, to make it 
truly a blessing to every afflicted one that enters its doors, 
a spot where only kindness and genuine sympathy reign, 
and where all that is possible is done to mitigate the 
sufferings of our fellow-beings. 

The Pennsylvania Hospital for the Insane was opened 
for the reception of patients on the first day of 1841, 
since which 1753 have been received, and 821 have left 
us, restored to perfect health ; while a large number have 
returned home, with various degrees of improvement. 

The institution has been steadily acquiring a firm hold 
on the confidence of the friends of the afflicted, and of 
the community, and every one connected with it is ex- 
pected so to act in all things as to prove that this confi- 
dence is not misplaced, but that even a higher degree of 
it will yet be deserved. 

The treatment of the insane was formerly but little un- 
derstood, and it is to be feared that many abuses and cruel- 



INTRODUCTORY REMARKS. i 

ties of a revolting nature were practiced upon patients by 
their ignorant and unfeeling attendants, to the lasting in- 
jury of the sick ; and the eternal disgrace of those guilty 
of participating in them. 

Although the prevalent views of that period may have 
offered some excuse for such proceedings, no such reason 
can be tolerated for a moment now, when it is as clearly 
demonstrated as is the existence of the sun on a bright 
noonday, that insanity, in all its forms, various as they 
are, is a disease, the subjects of which are never to be 
exposed to a rude remark or a rough act, but who are 
always to be treated with courtesy, respectful kindness, 
and sympathy — who are to be aided on all occasions in 
finding means with which to interest, amuse, or employ 
themselves, and who are ever to have excuses made for 
the wayward, irritable, violent, or careless acts which 
spring from a disease over which they have no control, 
and which destroys responsibility for their actions. 

These are the only views of this disease that can be 
held by those about the insane that will allow full jus- 
tice to be done to the patient. Every one must remem- 
ber that the engagement to perform duties in an institu- 
tion for the insane implies an obligation on his part, 
religiously, and to the best of his abilities, to carry out 
all rules, prepared by the proper authority, in their true 
spirit, and to submit without a murmur to such acts 
of patients as spring from their disease. By a uniform 
course of steady, unwavering attention, gentleness, kind- 
ness, and sympathy towards every one under their care, 
all employed will certainly command the confidence of 
those directing the institution, will win the gratitude of 
the afflicted, and, above all, secure the approbation of 
their own consciences. 



8 INTRODUCTORY REMARKS. 

Insanity is no respecter of persons ; no one can claim 
an entire exemption from it \ and none of us know how 
soon we, ourselves,, or some of our dearest friends, may 
require the very attentions we are now giving to stran- 
gers. Let us ask ourselves, when almost worried out with 
our charge — when on the point of forgetting that we have 
to do with those who are not responsible for their actions 
— what kind of treatment we would wish for ourselves or 
our relatives, when similarly afflicted, what steady kind- 
ness, what persevering attention, what delicate sympathy 
under all circumstances — and we shall know what is due 
to others. Never let us forget that motto, which, above 
all others, is appropriate in every institution for the in- 
sane — " ALL THINGS WHATSOEVER YE WOULD THAT MEN 
SHOULD DO TO YOU, DO YE EVEN SO TO THEM." 

Come what may, the law of kindness must be the go- 
verning one in this institution, and all other qualifications 
will pass as nothing, if the disposition to carry out this 
law is absent. Those who do not at heart adopt this sen- 
timent are unfit to take charge of the insane, and those 
who violate this principle are not wanted here; they are 
unfaithful to their trust, and can never do themselves 
credit in taking care of such patients, nor aid in promot- 
ing the prosperity of this institution. 

It will almost invariably be found that, where we can- 
not succeed in our object by mild measures, force will fail, 
and disputes, violence, and recriminations are always pro- 
ductive of injurious effects. To perform properly the 
duties of any station connected with the insane, requires 
high moral feelings, great self-denial, and a severe school- 
ing of the temper and disposition. If this is thoroughly 
done, every one is enabled to become highly useful in one 
of the most exalted fields of benevolence. Simply to 
perform special duties is not all that we require ; we wish 



INTRODUCTORY REMARKS, V 

to see an active interest felt in all tbe patients — a desire 
to add to their comfort in every way, and to advance their 
cure — steady efforts to interest or amuse them — a watch- 
ful care over their conduct and conversation, and a con- 
stant sympathizing intercourse, calculated to win their 
attachment, and command their respect and confidence. 

All situations about the insane are well known to be 
arduous and responsible, but a faithful performance of 
duty in any one of them cannot fail to give a kind of 
character that must prove useful in other walks of life ; and 
it is sincerely hoped that many who may be employed 
hereafter in this institution, like not a few who have left 
us, will in after years look back with satisfaction, not only 
upon the good they have been instrumental in conferring 
upon their suffering fellow-beings, but upon the direct 
benefits they have themselves derived from a residence in 
the institution. 

While we are employed here, we must never allow our- 
selves for a moment to forget that this noble institution 
was prepared for the benefit and happiness of its patients, 
and not for our convenience or advantage, and that to pro- 
mote the former, we must all expect to submit to many 
little annoyances, inconveniences, and privations. 

The Board of Managers having intrusted to the under- 
signed the general superintendence and direction of every 
part of this establishment, he looks forward with confi- 
dence from all, for that cheerful obedience to rules, and 
that zealous and prompt performance of duties at all times, 
which will add greatly and certainly to the happiness of 
the patients, and to the reputation and usefulness of the 
institution. 

THOMAS S. KTEKBRTDE, 

Physician to the Hospital. 
2* 



OFFICERS. 



By the by-laws of the Pennsylvania Hospital for the 
Insane, the resident officers of the institution consist of the 
Physician, Assistant Physician, Steward, and Matron. 

By these by-laws, the physician is made the official 
head of the institution, having a general superintendence 
and control of it, and of all persons employed on the pre- 
mises; and among his duties is prescribed that of making, 
with the sanction of the attending managers, such regu- 
lations for the government of all engaged in any way 
about the patients, as he may deem proper. The first 
edition of these rules was prepared before the opening of 
the hospital, in 1841, and the present code is only modified 
and extended in such respects as experience has shown to 
be desirable, to secure more fully the grand objects of the 
institution. 

In the performance of their respective duties, all the 
officers feel bound to know, by frequent personal inspec- 
tion, that every department of the institution is properly 
carried on — that all persons are faithful to their trusts — 
and that the patients are in every way properly treated 
and attended to. To do this, they must necessarily make 
frequent visits to every part of the house, and each one 



OFFICERS, 11 

engaged in any department will be careful to receive these 
visits kindly and respectfully, and on all occasions to 
attend to the suggestions that may be made in a prompt 
and cheerful manner, as the other officers are expected at 
all times to report to the physician, without reserve, the 
results of their observations. 

When the physician is absent, he is represented by the 
assistant physician, who will be applied to in reference to 
the patients and attendants. 



GENERAL RULES. 



In making engagements with individuals to take charge 
of the patients of this institution, it is to be distinctly un- 
derstood that the hospital contracts for their whole time, 
and that they are not to leave the premises or their duties, 
nor engage in work of their own, without express permis- 
sion from the physician. 

They are expected to perform with cheerfulness, and to 
the best of their abilities, all duties that may be assigned 
them by the officers of the house, and at all times and in 
all places to do what they can to promote the comfort and 
happiness of the patients, and the prosperity of the insti- 
tution. 

They are to treat the patients, every one having busi- 
ness at the institution, and each other, with respect and 
courtesy. They are to be neat in their dress, avoid wear- 
ing their hats in the house, going in their shirt sleeves 
(unless when specially at work in the wards), lounging on 
settees, the use of profane language, all vulgar habits, and 
every kind of act unbecoming their position. Like the 
officers and patients, they are expected to forego the use 
of tobacco and intoxicating drinks of every kind while in 
the employ of the hospital. 



GENERAL RULES. 13 

When the officers or visitors are present in the wards, 
hey will rise, and be prepared to give such information 
as may be required of them. 

When abroad, they are to avoid reporting the conduct, 
conversation, or names of patients, and are never to speak 
disrespectfully of the institution or any of its officers. 

No one belonging to the North Wing, nor any male 
employed on the premises, is to enter the South Wing on 
any pretence, or go upon the grounds appropriated to the 
female patients, without express leave. 

It is so highly important that patients should, as far 
as possible, be kept constantly at some pleasant kind of 
employment — either work of some kind, or riding, walk- 
ing, or amusements — that no suitable opportunity is ever 
to be neglected to induce the patients thus to occupy 
themselves. 

While cheerfulness is always desirable in the wards, 
marked levity of conduct is unbecoming and undesirable 
among the insane, and all should be careful to make this 
important distinction. 

It is very desirable that patients should leave the insti- 
tution with pleasant recollections of their stay in it, and 
every one coming in contact with them can do much to 
promote this end. Although the testimony of an insane 
person, of course, is often not to be depended on, and 
while a few even after recovery seem to labor under some 
delusion as to what happened during their sickness, still 
it is undeniable that, in most cases, patients who have 
recovered are quite competent to give a correct account 
of what occurred during their sickness, of the treatment 
they received from those about them, and much other 
information highly important to those managing hospitals. 
1 It is hoped that in all cases this testimony will be such 



14 GENERAL RULES. 

as to increase the standing and respect due to those having 
the immediate care of the patients in this institution. 

When absent, the hour for return in the evening is 
half past nine. At a quarter before ten, the gate will be 
locked, and no person admitted afterwards without being 
reported to the proper officer. 

As this code of rules has been made to promote the 
welfare of the hospital and its inmates, and the comfort of 
every one connected with it, it is hoped that violations of 
them will rarely occur, and that all will feel bound to do 
what they can to secure obedience to them, and never 
take offence when their defects are pointed out or im- 
provements suggested. 



DUTIES OF THE SUPERVISORS. 15 



DUTIES OF THE SUPER VISORS. 

The supervisors of the respective wings are bound to 
see that the rules contained in this code are faithfully 
carried out in every particular; that the attendants per- 
form their duties properly ; and that all the patients are 
made as comfortable at all times as circumstances will 
permit. 

They will very frequently pass through the different 
wards, especially those containing excited patients, and 
occasionally through the pleasure grounds, and will aid 
and encourage the attendants in their efforts to interest, 
amuse, and employ the patients in every way in their 
power. 

They will especially attend to the prevention of dis- 
turbances among the patients, to the preservation of order 
and quiet in the house, and in all things assist in carrying 
out the general views and instructions of the physician in 
reference to the treatment of the patients. 

They will promptly report all irregularities or improper 
conduct or unfaithfulness in the performance of duties 
that come under their notice, will give advice to the 
attendants, and point out any neglect that they may dis- 
cover in any of the wards. 

They will keep a daily journal of their observations, 
which they will place in the office each morning for in- 
spection by the physician previous to his regular visit. 



16 DUTIES OF THE TEACHERS. 



DUTIES OF THE TEACHERS. 

The teachers are expected to make themselves com- 
panions to the patients, and in the performance of their 
duties to aid in the supervision of the wards. 

They will pass through the different wards frequently 
in each day, will advise the patients in the selection of 
books, encourage them to engage in the different kinds of 
employment, suggest means of amusement, and by their 
conversation and example do all in their power to promote 
their happiness, and aid in carrying out the wishes of the 
physician. 

As may be directed by the physician, they will impart 
instruction to certain patients, read and superintend 
amusements, in the different wards at stated hours, and 
take such part in the entertainments in the lecture-room 
as may be deemed desirable. 

They will, while in the different wards, carefully ob- 
serve the general treatment of the patients, and they are 
to suggest to the attendants whatever they think will add 
to the comfort of the patients or the tranquillity of the 
wards, and will report any neglect or improper conduct 
that may come under their notice. 

They will keep a journal of their observations, which 
they will place in the office, each morning, for inspection 
by the physician previous to his regular visit. 



DUTIES OF ATTENDANTS. 17 



DUTIES OF ATTENDANTS. 

1. Intercourse with Patients. — In all their inter- 
course with the patients, the attendants are to treat them 
with respect and civility, are to address them in a mild 
and gentle tone of voice, and avoid violence and rudeness 
of every kind. All civil questions are to be properly 
answered. All reasonable requests are to be promptly 
attended to. They are to keep cool under every provo- 
cation ; are never to scold, threaten, or dictate authorita- 
tively; but, whenever they desire anything done by a 
patient, are to make a request in a respectful manner. 

Force, unfortunately, has sometimes to be used in every 
institution for the insane ; but tact and kindness render 
its employment comparatively rare, and whenever it must 
be resorted to, the manner of using it may be made to 
take away nearly all its offensiveness. A pleasant smile, 
a cheerful, kind, and respectful manner, and sympathizing 
words, will go far to convince even the most excited pa- 
tient that what is done is from good motives, and that he 
has little to fear from those around him. 

The opposition of patients, and much of their violence, 
very often arise from delusions that lead them to suppose 
that they are to be injured in some way; and every at- 
tempt either to put them in a room, to give food, baths, 
or medicine, or to do anything about their persons, if 
3 



18 DUTIES OF ATTENDANTS. 

made with angry looks, cross words, or violence, only 
tends to confirm their false ideas and make their resist- 
ance the more obstinate and determined. 

The truth of these views is unquestionable, and is con- 
firmed daily by convalescent patients, who are able to 
describe their motives and feelings when highly excited. 

Under no circumstances will an attendant be excused 
for striking a blow, or laying violent hands upon a patient, 
unless in the clearest case of self-defence, or to prevent 
his committing serious injury to himself or others. 

Attendants are never to manifest fear of any patient, 
but, while treating them with firmness and decision, at 
the same time it must be with mildness and kindness. 

They must take every proper opportunity to inspire the 
patients with respect for and confidence in the officers, and 
to convince them of the true character of the institution, 
and of its leading object, the promotion of the restoration 
and comfort of its patients. 

They are promptly to interfere when patients are dis- 
posed to quarrel, and by kind words, and engaging their 
attention with other objects, prevent difficulty. A kind 
word fitly spoken will prevent many a scene of excitement, 
just as a harsh remark, an angry look, an unkind allusion, 
or a rude act, on the part of an attendant, may be the 
origin of difficulties which will last for hours. 

They are to carefully avoid talking to patients on the 
subject of their delusions, or to others in the hearing of 
the patients, and, as much as lies in their power, they 
should endeavor to prevent others from doing so. 

They must never allow patients to be laughed at, ridi- 
culed, or harshly spoken to on account of their delusions 
or the peculiarities of their behavior. No greater proof 



DUTIES OF ATTENDANTS. 19 

of a want of correct feeling could be given than indulging 
in levity in reference to the afflictions of our fellow-beings. 

Deception is always to be avoided, and particular care 
is to be taken that promises are not made that cannot be 
performed. 

They are not to furnish writing materials or books to 
the patients, nor make purchases for them, without con- 
sulting the physicians. 

All letters, parcels, or packages (except clothing) to or 
from patients are to pass through the hands of the physi- 
cian. When patients have tobacco, or forbidden articles 
of any kind, it is the duty of the attendant promptly to 
report it. 

All damage done by patients is to be entered on a book 
provided for the purpose, and through the supervisor de- 
livered to the steward at the end of every week. 

2. Supervision of Patients and Wards. — Each 
attendant is responsible for every patient under his or her 
care, and is expected to be able at any moment to say 
where each individual can be found. 

If any one is discovered to be missing, report is to be 
immediately made to the supervisor and one of the officers, 
and the proper search instantly instituted. 

An attendant allowing a patient to go out of a ward is 
considered responsible for his or her safe return. 

One attendant must always be present with the patients 
in each ward, unless express directions are given to the 
contrary. When it is necessary to leave, except for a 
very temporary purpose, it must be known that a substi- 
tute fills the place. 

When patients remain much in their own rooms, the 
attendants are to find reasons for frequently calling to see 



20 DUTIES OF ATTENDANTS. 

how they are engaged, or if they require any particular 
attention. 

On certain occasions, one attendant may guard two 
contiguous wards for a very short period — but not other- 
wise, unless by special direction of one of the physicians. 

3. Morning Duties. — The attendants will rise punc- 
tually at the ringing of the bell, and take charge of their 
wards before the night watch goes off duty. They will 
then open the chamber doors, give the patients a kind 
greeting, at least wish them "good morning," and see 
that they are properly dressed, well washed, and have 
their hair and clothes neatly brushed. 

Immediately after opening the doors, the attendants 
will remove the chamber utensils, never without being 
covered, from the rooms, and have the bedding laid on 
chairs for airing. They will then commence putting the 
rooms and corridors in good order, and, after the beds and 
bedding have been sufficiently aired, have them properly 
made up for the day. 

Every part of the wings is to be prepared for inspection 
at the physician's visit, which will be commenced not 
later than eight o'clock every morning. 

4. Cleanliness and Ventilation of the Wards. — 
Every part of the wards is to be kept scrupulously neat, 
clean, and well ventilated at all times. 

"Whenever any unpleasant effluvium is discovered, the 
cause of it is to be searched for and promptly removed, 
day or night. 

When any part of a parlor, chamber, or hall is acci- 
dentally soiled, it is to be cleaned at once. 



DUTIES OF ATTENDANTS. 21 

Whenever a bed or the furniture of a room has been 
disarranged, it is to be promptly put in order. 

The halls and parlors must be swept as often in each 
day as is necessary to keep them perfectly clean. 

If an attendant from one ward, in passing through an- 
other, spills oil, medicine, &c, he is bound at once to 
clean the place. 

Unless directions are given to the contrary, the cham- 
bers and corridors are to be scrubbed at least once a week, 
and as much oftener as may be required. 

The spittoons are to be kept clean, and frequently 
emptied. The water closets, urinals, &c, are to be care- 
fully watched, and prevented from impairing the purity 
of the air in the ward. 

Nothing is clean enough if it can he made cleaner. 

All beds that are soiled are to be removed from the 
wards immediately after the patients rise in the morning 
— and after breakfast clean ones are to be substituted. 
If only wet, the wet straw or hair is to be removed, and 
boiling water poured through the soiled part, after which 
it is to be thoroughly dried before being returned to the 
chamber. 

A clean sheet and pillow case are to be put on each 
bed at least once a week, and when the spreads become 
soiled they are to be sent to the wash-house. 

When patients wish to lie down during the day, they 
are to go to their own rooms for the purpose — and the 
attendants will see that the bedding is not soiled, and that 
it is put in order as soon as they get up. The health of 
many patients requires this indulgence every day, 

5. Meals and giving Food. — The attendants will 
see that the patients are always up and ready for 

3* 



22 DUTIES OF ATTENDANTS. 

breakfast, at the prescribed hour. They will carefully 
observe that they pass to and from the table in good 
order, returning directly to the wards when they leave the 
dining-rooms. 

When patients take their meals with the officers in the 
centre building, they are to be accompanied thereto, un- 
less they have the full privilege of the grounds. 

Those patients who take their meals in their own rooms, 
or at a table in the ward, are to be served promptly, and 
especial care is to be taken that their food is brought to 
them warm, and in good order, and, whenever necessary, 
an attendant is to remain with them while they are eat- 
ing. 

Care is to be taken that no knife, fork, or other article 
that could be used as a weapon, is left in the ward, or 
taken from the tables. When any such instrument is 
missed, prompt measures must be taken for its recovery. 

The attendants will not leave their wards for the pa- 
tients' meals, nor for their own, till the ringing of the bell 
to call them for these purposes. They will return 
promptly to their wards after finishing their own meals. 

The steward and matron will visit, as often as possible, 
all the dining-rooms, during the hours for meals, and also 
have a supervision of the mode in which patients have 
their meals served to them in the wards, or in their 
rooms. All deficiencies or wants are to be promptly re- 
ported to these officers, and their instructions on these 
points are to be strictly attended to. 

Patients are never to be forced to take food but in the 
presence of one of the physicians, the steward or matron, 
the supervisor or teacher — and never but by the express 
direction of one of the physicians. 



DUTIES OF ATTENDANTS. 23 

6. Administration of Medicine. — The trays con- 
taining the medicine cups will be called for at the office 
by the supervisor, or such person as may be indicated by 
the physician, half an hour before breakfast and dinner, 
and at 7 P. M. The attendants will receive their trays 
as they are carried through their respective wards, admin- 
ister the medicine, see that it is all properly taken, wash 
the cups, and have the trays ready to be sent back by the 
individual who calls for them when returning to the office. 
If there has been any difficulty in taking the medicine, 
the attendants will report the fact to the person carrying 
the trays, who will make a verbal report to the assistant 
physician, or a register of it on a book which he will leave 
at the office on his return. 

The utmost gentleness is to be used in giving medicine, 
and every proper means employed to induce the patient 
to take it willingly. When it is positively refused, and 
the physician believes its administration important, either 
the assistant physician, steward or matron, supervisor or 
teacher, must be present, before any force can be used. 

When the attendants suppose any mistake has occur- 
red in the medicine sent, or when a patient complains of 
being sick, or having any unusual symptoms, the medi- 
cine should be retained in the cup till one of the physi- 
cians can be seen upon the subject. 

Any striking or unexpected effect in the operation of 
medicine is to be promptly reported. 

When a patient complains of being sick, or is supposed 
to be so, the fact should be reported without delay to one 
of the physicians. 

The person carrying the medicine from the office can- 
not select a substitute, on any occasion, without the con- 
sent of one of the physicians. 



24 DUTIES OF ATTENDANTS. 

7. Bathing. — Unless a special exemption is made by 
the physician, every patient will take a warm bath once 
a week. The temperature to be such as is most grateful 
to the patient. 

Unless otherwise specially directed, hot baths, adminis- 
tered for medical purposes, will be given at a temperature 
of 98°, as shown by the thermometer, and this tempera- 
ture is to be kept up by the addition of hot water as may 
be required. While in these baths, the patients are to 
have a towel frequently wrung out of cold water, kept 
constantly on the head. Where it can conveniently be 
arranged, immediately before retiring to bed is the best 
hour for giving this kind of bath. When not otherwise 
directed, and the patients exhibit no weakness, they should 
remain in the bath thirty minutes. If the patient ap- 
pears weak, or complains of any unusual symptoms, he 
should be taken out of the bath, and promptly placed in 
bed. When these baths are ready for use, the supervisor 
or teacher should be informed, that they may be present. 
Mustard foot baths should be used at as high a tempera- 
ture as the patient can comfortably bear, and the addition 
of hot water will occasionally be required to keep up the 
temperature. From one to two tablespoonfuls of mustard 
should be put in each bucket of water. The feet should 
be kept in the water not less than twenty-five minutes. 
These baths should be taken immediately before going to 
bed. On lecture nights they are to be given after return- 
ins: from lecture. No one able to attend a lecture should 
ever be kept from it to take a bath, which should be given 
afterwards. 

8. Shaving. — The shaving of patients is to be done 
by the attendants in each ward at stated intervals, and 



DUTIES OF ATTENDANTS. 25 

patients who desire to be shaved more frequently are to 
be gratified in this particular. Great care is to be taken 
that no injury is done with the razors, all of which are 
to be carefully kept by the attendants. When the phy- 
sician has allowed a patient to shave himself, an attendant 
must always be present, and no other patient in the room 
at the time. 

9. Walking out with Patients. — It is desirable 
that every patient not too feeble, or too sick, should walk 
out about the grounds at least once in each morning, and 
once in each afternoon. 

Immediately after the physician's morning visit, in 
suitable weather, one attendant in each ward should pre- 
pare to go out with as many patients as it is proper to 
take at once — the other attendant remaining to do the 
work of the ward. Upon the return of the first company, 
a second should go out, and so on till all in the ward 
have had the proper amount of exercise. In the after- 
noon, the same plan should be adopted and continued till 
near tea time. 

When walking out with patients, the attendants will 
as far as possible consult their wishes, in regard to the 
direction of the walk, &c. — will be vigilant to keep them 
together and prevent their strolling — take care that those 
from different wards mix as little as possible, and that no 
more are taken in one company than can be properly 
attended to. 

When patients' habits are careless, the attendants will 
see that they do not lie on the ground, or improperly 
expose themselves to the sun, &c. 

Attendants, when out with patients, will avoid entering 
into conversation with each other, reading, &c, by which 
their proper supervision may be prevented. 



26 DUTIES OF ATTENDANTS. 

No patient can remain out after tea in summer, nor 
after sunset in winter, without special permission from 
the physician. 

All patients going out to walk beyond the yards must 
be accompanied by an attendant, unless the physician has 
given them the privilege of the grounds. Those having 
this privilege are expected always to be punctual at meals 
and in returning to the ward — are to avoid entering the 
centre building or basement story, or remaining standing 
about the gateway, or on the pathway leading from it to 
the centre. 

If any patient, having the privilege of the grounds, or 
absent by special permission, does not return at the ap- 
pointed hour, the attendant in charge will report the fact 
to any of the officers, and ascertain the reason therefor. 

Patients are not to be taken upon the dome without 
special permission. 

Patients are not to walk outside of the enclosure either 
with or without attendants on the Sabbath, except to 
attend a place of worship. 

Only those patients who conduct with entire propriety 
are to walk in the centre yard, and after 8£ P. M. all 
employed are to avoid walking there. 

New patients are not to be taken outside of the en- 
closure till the physician has signified his approbation of 
their having this privilege. 

When attendants wish to take a company outside of 
the enclosure, they will first report to one of the physi- 
cians, or to the supervisor, whom they propose taking, 
where they are going, and how long they expect to be 
absent. 

When outside with patients, attendants will be espe- 
cially careful to avoid crowds, railroads, and all other 



DUTIES OF ATTENDANTS. 27 

dangerous places. They will strictly avoid paying any 
visits when they have patients with them, or entering any 
tavern or house for any purpose. 

The physician alone gives the privilege of the grounds, 
or permission to patients to pay visits at home or else- 
where. 

10. Patients at Work and Out-door Attendants. 
— Such patients as are deemed suitable will be allowed 
by the physician to go out to work, under the care of the 
out-door attendants, gardener or farmer; but no one is to 
be taken out of the wards for this purpose, unless some 
general permission of the kind has been previously given 
by this officer. The attendants will take especial care 
that the patients do not engage in improper kinds of 
labor, and that they do not overwork themselves. 

These patients must always be kept under observation, 
and when a strong disposition to escape is manifested, 
they must be constantly near the attendant. 

No patient should be taken out of a ward to work, or 
for other purposes, by an officer or by any other person, 
without mentioning the fact to one of the attendants. 

All attendants are expected to go out and work with 
patients, whenever it is deemed desirable for them to do 
so; and when thus engaged, they will carefully avoid 
every appearance of superintending the patients, instead 
of working with them, but should induce them to labor 
by persuasion and example, and not by giving orders to 
them. 

11. Beading in the Wards, and Lecture-room 
Entertainments. — Immediately after tea, on the eve- 
ning of every Sabbath, the patients of the different wards, 



28 DUTIES OF ATTENDANTS. 

who are sufficiently calm, will assemble in the two large 
rooms in the centre building to listen to the reading of 
the Holy Scriptures. One attendant from each ward will 
invariably attend with the patients under his or her care, 
and who should be properly solicited to be present. 
When, from any cause, an attendant cannot be spared 
from a ward, the supervisor will arrange who shall re- 
main in care of the patients. 

At 5 P. M. of each Sabbath, the teacher of each wing 
will read portions of the Bible to the patients of the 6th 
and 7th wards, at which reading one attendant must 
always be present. 

On certain evenings of each week, the teachers will 
read to the patients of the 3d and 4th wards, in the parlor 
of the 3d ward. The attendants will take pains to have 
all attend who are suitable, and one attendant from each 
of these wards will always be present. 

The same course is to be observed in the reading to 
the patients of the 6th and 7th wards. 

On the evenings of entertainments or lectures in the 
lecture-room, one attendant must be present from each 
ward from which patients attend, the other attendant 
remaining in the ward to take charge of it during that 
period, unless, under certain circumstances, one attendant 
is left to take charge of two adjoining wards. But all 
attendants not employed in taking charge of the wards 
are expected to be present with the patients in the lecture- 
room. 

12. Retiring at Night. — Patients are not to retire 
before 8 P. M. without permission, unless in cases of 
sickness or fatigue. After the bell rings at 85 P. M., 
patients may retire in every part of the house. Those in 






DUTIES OF ATTENDANTS. 29 

the first and second wards may remain up afterwards, 
according to their wishes, so that they retire in time to 
allow the attendants to close their doors at half-past nine. 

Attendants, as well as patients, are expected to be in 
their rooms at a quarter before ten o'clock, and after ten 
o'clock no light can be kept burning in any room, unless 
in case of sickness. In each ward, however, one light 
will be kept burning in the hall, to be used in cases of 
emergencies. 

After patients have commenced retiring, all persons are 
to be careful to avoid making a noise of any kind that 
might disturb those who are in bed. 

In the 3d, 4th, 6th, 7th, and 8th wards, the clothing 
of patients, unless when otherwise directed, is to be kept 
outside of the rooms, always neatly folded and placed on 
a chair or settee near the door, and is to be handed in to 
the patient when the door is opened in the morning. 

Where patients lodge in a different ward from that in 
which they pass the day, it is the duty of the attendant 
having them in charge during the day to take them to 
their rooms and see them comfortably in bed, unless other- 
wise directed ; and it will also be the duty of the attendant 
of the ward in which they sleep to see them up and 
dressed in the morning, and returned in seasonable time 
to the ward from which they came the previous evening. 

Before closing the door, the attendant should wish the 
patient a good night, and be certain that he is actually in 
the room. The door is then to be locked and tried, to 
ascertain that the bolt has properly slipped. 

No patient's door is ever to be left unlocked at night, 
without special permission from the physician being given 
to the attendants of the ward and to the night watch. 
4 



30 duties of attendants. 

13. Seclusion of Patients in their Rooms. — 
Whenever a patient becomes so noisy or so violent that 
the attendant, after trying all proper means, believes it 
necessary to place him in a private room, he should pro- 
vide such assistance as will convince the patient that 
resistance will be useless. It must then be done in the 
most mild and gentle manner possible. When the pa- 
tient is in the room, the attendants should sit down quietly 
by him, and calmly tell him why he has been placed 
there, and that he will be released as soon as he is able 
to control himself. No matter how unreasonable the 
patient appears, this should always be done. Under no 
circumstances can it be justifiable to force a patient into 
a room, and suddenly close the door, without a word of 
explanation. 

A room having a wire or close shutter, and if possible 
a wicket door, is always to be selected for the seclusion 
of an excited patient. As soon as the patient is in the 
room, the fact is to be stated to one of the physicians, or 
a memorandum of it left on the office slate. 

Where it is necessary that patients should be secluded 
in their own rooms, the attendants should be careful to 
see to them frequently, to ascertain that they have every- 
thing proper that can minister to their comfort, and to 
know in what manner they are occupied. 

When a patient is very violent, one person on each 
side taking an arm, and a third at his back, can almost 
always convey any ordinary individual to his room, or re- 
move him from ward to ward, with but little difficulty or 
injury to any one. 

14. Restraining Apparatus. — The use of restrain- 
ing apparatus is productive of so many and such serious 



DUTIES OF ATTENDANTS. 31 

evils, and is now so nearly abolished in all well-conducted 
institutions for the insane, that it will not be permitted 
to be applied here in any case, except by the express 
direction of the physician of the institution, or, in case of 
his absence from the premises, by that of the assistant 
physician. 

Seclusion to a private room, and the personal care of 
attendants, must be relied on till the physician can be 
found, and his directions in reference to future proceed- 
ings given. It is, in most cases, much better for one or 
two attendants to sit by a patient for several hours than 
to put on any restraining apparatus, although the latter 
may in very rare cases ultimately be necessary, and even 
beneficial. 

Whenever patients are fastened on the bed by the ap- 
paratus used for that purpose, or when their hands are 
confined in any way, the attendants must never forget 
that, thus situated, they require constant attention, as they 
are unable to assist themselves, and may thus easily get 
into habits that will afterwards give great trouble and 
annoyance. 

15. Escapes. — The escape of patients is always ex- 
ceedingly annoying, and, although such events will occa- 
sionally occur, it must never be allowed to be from neglect. 

Patients are more apt to escape when passing from one 
part of the building to another, or when allowed to pass 
out for some particular purpose — or if near a crowd, or 
in the streets of a city — or about twilight. At such times 
and in such places, therefore, they must be particularly 
watched. 

An attendant's eyo should always be kept on a patient 
known to be disposed to escape. 



32 DUTIES OF ATTENDANTS. 

When it is clearly made out that a patient has escaped 
from the carelessness or neglect of an attendant, the ex- 
pense of recovering the patient will be charged to the 
attendant, at the discretion of the physician. 

When a patient is found to be missing, a search should 
at once be instituted where the individual was last seen, 
and if any traces are discovered, pursuit should be in- 
stantly made. But, if not discovered at once, the fact 
should be promptly communicated to one of the physi- 
cians, or other officers or supervisors, and any other at- 
tendant that may be met with. The officers will then 
give directions what course is to be adopted to recover the 
patient. The attendant following the patient should, if 
possible, leave word in what direction he proposes going, 
and should know that some one takes special care of the 
patientshe leaves. When a patient is brought back, no 
offensive allusion is to be made to the escape ; but he is 
to be treated in all respects as if nothing of the kind had 
occurred, except that he is to be watched more carefully 
in future. 

16. Suicidal Cases. — When patients have a disposi- 
tion to commit injury on their own persons, all experience 
goes to show that there is no certain security but by con- 
stant watching. Care should be taken to place out of 
reach all the means that would be likely to be resorted 
to, and the patient must be kept constantly in sight, 
treated with great kindness and sympathy, and his atten- 
tion drawn as much as possible from the subject. It 
must never be forgotten that, in a bad case, a single 
minute of neglect may be as serious in its effects as a 
whole hour. 

Before placing such a patient in his room, it should be 



DUTIES OF ATTENDANTS. 33 

carefully inspected ; and when the clothing is taken off, it 
should be examined or removed entirely from the chamber. 

Especial care is to be taken of such patients about twi- 
light, or while others are going to or passing from meals, 
or to or from lectures, and at all times when the general 
attention is likely to be distracted, as these are the hours 
when attempts are most likely to be made. 

In case an attendant should ever discover that such an 
accident has occurred, he must maintain his coolness, give 
prompt relief if any can be rendered, then lock the door, 
quietly inform one of the physicians or other officers, the 
supervisor, teacher, or another attendant — but give no 
alarm that would excite other patients, or do anything 
that would lead them to discover what has occurred. 

. 17. Dangerous Weapons. — Especial care must be 
taken at all times that patients do not become possessed 
of knives, razors, or dangerous weapons of any kind. 
Frequent search for such articles must be made in the 
wards, and when the existence of any is suspected, every 
possible means must be used to discover them. 

Anything seen lying about the wards, yards, or grounds 
that might prove dangerous in the hands of a violent 
patient, should be carefully and promptly removed. 

18. Prohibited Articles. — It is strictly prohibited 
to patients to use tobacco in any form, while under the 
care of this institution. It is a filthy habit, and experi- 
ence has satisfactorily shown that it is injurious to most 
persons, and to many excessively so. 

No patient is to have in his possession any razor, knife, 
or other article that in his own hands or the hands of 
others might be used as a dangerous weapon. 

4* 



34 DUTIES OF ATTENDANTS. 

Patients are not to receive or forward any letters, par- 
cels, or packages of any kind, without the knowledge and 
approbation of the physician. 

19. Patients' Clothing. — The clothing of every 
new patient is to be examined at the earliest opportunity 
after admission, to ascertain whether there are knives, 
weapons of any kind, money, tobacco, or other forbidden 
articles upon his person. If any are found, they are to 
be promptly given to the steward for safe keeping. 

The clothing of a patient is not to be taken into a ward 
until it has been examined, and a list of articles taken by 
the steward or matron. All new clothing sent to a pa- 
tient should pass through the same hands, and be regis- 
tered in the same way, before it is used. No unmarked 
clothes should go to wash, or be used by a patient. 

The attendants will carefully see that patients change 
their clothes regularly, and all reasonable requests in 
reference to changing clothes are to be gratified. 

Soiled clothes are never to be allowed to remain in a 
patient's room, but are at once to be put among those to 
be sent to the wash-house. 

The clothing of patients is to be kept neat and clean, 
and well brushed at all times. If buttons are found to 
be missing, or holes are seen in a garment, it is to be 
taken at once to the seamstress to be repaired. If sus- 
penders or other necessary articles in the wards are found 
wanting, they are to be asked for till they are furnished. 
Shoes are to be kept tied — stockings gartered — clothing 
buttoned or fastened, at all hours, and on all patients. 

When patients wet their clothing, they are to be changed 
as often as may be necessary to make them dry and com- 
fortable, even if every hour. The wet part of their cloth- 



DUTIES OF ATTENDANTS. 35 

ing may be dipped in hot water and dried, but is not to 
be returned to the ward without undergoing this process. 

Pains are to be taken to induce patients to be neat in 
their dress, to wear slippers when within doors, and in 
wet weather to change their shoes after walking out. 

In the South Wing, the attendants are expected, under 
the instructions of the matron and supervisor, to take 
charge of the patients' clothing, and see that it is carefully 
preserved and kept in proper order and repair. They 
will also take charge of any new work or work to be 
repaired that may be sent into the ward, occupy them- 
selves with it, and encourage the patients to give them 
such aid as will be useful. Attendants can do no private 
work, except putting their own clothes in order, during 
the hours of duty, without special leave, nor can they 
employ the patients to do work for them, if there is any 
required for the house, without the same permission. 

20. Visiting between Wards. — As the duties of 
each attendant are confined almost exclusively to a single 
ward, they can have but rare calls in any other unless 
specially directed by the proper authority to go there. 

In going to and from the centre building, they will 
avoid passing through wards not necessarily in their way. 

Patients, too, are not to visit from ward to ward, with- 
out permission from one of the physicians — and no patient 
is to be transferred from one ward to another except by 
special direction of the physician, unless some high excite- 
ment may induce the assistant physician to change a pa- 
tient temporarily. 

21. Leave of Absence. — To those whoperform their 
duties faithfully, it is wished to allow as much relaxa- 



36 DUTIES OF ATTENDANTS. 

tion and as much absence as is consistent with the kind 
of service required, and the welfare of the patients will 
permit; but, whenever the absence of attendants is deemed 
likely to be prejudicial to the patients, they are expected 
to remain at their posts. 

Leave of absence is granted only by the physician. If 
he is absent more than an entire day, the assistant phy- 
sician is to be applied to, but not otherwise, except under 
extreme circumstances. 

The usual time for absence will be from 1£ P. M., or 
after the patients' and attendants' dinner is entirely 
finished, till the ordinary hour of return in the evening. 

On lecture or concert evenings, all who may have been 
out during the afternoon are expected to return before 
tea-time. 

Promptness in returning at the hour up to which leave 
of absence was given is always to be carefully observed. 
If unforeseen circumstances positively prevent this for any 
length of time, word should be sent to the hospital. 

Without special permission, no one is to leave the pre- 
mises at any time, or for any purpose, unless in walking 
with patients, till after the patients begin to retire at 
8 P. M. They will be careful always to be inside the 
enclosure at half past nine, and in their own chambers at 
a quarter before ten. In returning to their rooms in the 
evening, care must be taken to avoid disturbing those 
who have retired, either by the noise of walking or loud 
conversation. 

An attendant should not leave his charge during the 
day, for any purpose, without the consent of one of the 
officers or of the supervisor. 

Permission should always be obtained to leave the ward 
before going out of it to see any visitor, and the absence 



DUTIES OF ATTENDANTS. 37 

should then be short ; and visitors are never to be taken 
through the house or grounds without permission. 

On the Sabbath, leave of absence is always supposed 
to be for the purpose of attending Divine worship. If 
granted for the morning, the attendants are expected to 
return before dinner; if in the afternoon, (leaving after 
dinner is fully over, not before lj P. M.,) to return by 
the ordinary hour in the evening. 

In the 6th and 7th wards, having three attendants in 
common, one will be allowed to go out each Sabbath in 
rotation, after breakfast is fairly over — provided their 
presence in the ward is not deemed necessary. 

When about to leave, the attendants will call at the 
office and put their keys on the hooks provided for the 
purpose, and report themselves either to one of the physi- 
cians, or leave their names and the hour of going out on 
a slate provided for the purpose, and in like manner re- 
port themselves on their return. 

They are never on any occasion to lend their keys 
to any person, and especially not to a patient, without 
directions to that effect from the physician. 

When attendants are absent from their duties for any 
length of time, on their own private business or for plea- 
sure, they will have the loss of time deducted on the 
settlement of their accounts, at the discretion of the phy- 
sician. 

Attendants and others employed in the house are not 
to visit the friends of patients, unless requested to do so 
by the physician. 

22. Notice to Leave and Discharges. — Whenever 
any one employed wishes to give up his situation, he is 
only required to give two weeks' notice of his intention. 



38 DUTIES OP ATTENDANTS. 

Whenever the institution wishes to dispense with the 
services of any one, the same notice will be given, or 
payment for that period, at the discretion of the physician. 

Whenever any one is discharged, however, for any 
violation of rules or improper conduct, no such notice will 
be given, nor -payment made but up to the time of dis- 
charge. 

As many very worthy and well-intentioned persons do 
not possess the natural qualifications to make them valua- 
ble in the care of the insane, the officers of the institution 
in all their engagements expressly reserve the right at 
any time to dispense with the services of any one by 
giving two weeks' notice, or by paying for that period, 
and this with or without assigning their reasons therefor. 
It can never be considered as any mark of disrespect, 
when an individual is not likely to gain credit or give 
satisfaction in a station, to give him an opportunity to 
embrace another pursuit better calculated to advance his 
own interest. 



DUTIES OP SPECIAL ATTENDANTS. 39 



DUTIES OF SPECIAL ATTENDANTS. 

Special attendants are governed by the same rules as 
other attendants. But, as their duties are commonly lighter 
than those of the general attendants, they must expect a 
closer confinement, and a less frequent absence from their 
charge. 

They are to be particularly careful in reference to those 
under their care — are never to leave them alone unless 
from special permission, and promptly and courteously 
attend to their rooms, clothing, &c, and to all reasonable 
requests that may be made to them, if not inconsistent 
with the general regulations of the institution. 

They are to exercise a general supervision of other 
patients in the same ward, take a part in keeping it in 
good order, and perform such other duties as may be 
required by the proper officers. 



40 DUTIES OF THE WATCHMAN. 



DUTIES OF WATCHMAN AND WATCHWOMAN. 

The watchman will commence his rounds at half-past 
nine o'clock, at which hour he will call at the physician's 
office for directions for the night. He will keep moving 
about from ward to ward, during the entire night, and 
will visit every part of the house (except that occupied by 
the female patients) at least every hour, frequently pass- 
ing on the outside of the hospital, and noticing the out- 
buildings. 

He will know that all employed about the North Wing 
are in their rooms at the prescribed hour, and, if he has 
a doubt on the subject, it is his duty to ascertain the fact 
by opening the individual's chamber door. 

He must be kind, gentle, and soothing in his manner 
to the patients, and take every means in his power to tran- 
quillize those that are excited, and to allay the fears and 
apprehensions of the timid. He will see that they are 
promptly supplied with water when it is asked for, and 
that all their little reasonable wants are attended to. He 
will be careful to make as little noise as possible in moving 
about, and always speak to patients in a low tone of voice. 

He will notice particularly all unusual sounds in the 
patients' rooms, and ascertain their cause, or give prompt 
notice to the proper attendant. 

When there are sick in the wards, he will pay them 



DUTIES OF THE WATCH WO MAN. 41 

frequent visits — attend to all their wants, and if required 
administer their medicine. 

He will report to the physician all irregularities, every 
instance of neglect, and all violations of rule that may 
come under his notice in any part of the house, or on the 
premises — and enter upon the office-book any remarks he 
may have to make upon the occurrences of the night. He 
will always report on this book particularly how new 
patients and those who are sick have passed the night. 

Should he discover fire in any part of the hospital or 
out-buildings, if it is not in his power at once to extinguish 
it, he will immediately give notice to the officers and then 
to the attendants, but never raise a general alarm. 

He is to ring the bell at the prescribed hour, start the 
fires in the kitchen, and perform such other duties as may 
be assigned him. 

The attendants being up, and in charge of the wards, 
at 6 A. M., his duties cease till 1 P. M., after which his 
time is at the command of the institution till sunset, from 
which hour he is relieved till 9£ P. M. 

The duties of the watchwoman are confined to the 
wards occupied by female patients, in which she will spend 
the night, and be governed by the same rules as the 
watchman. 

Both will be careful to perform their responsible trusts 
with the strictest fidelity — to be constantly vigilant, and 
never to sleep while on duty. Any suspicion of a want 
of fidelity in these officers must necessarily disqualify 
them for their stations. Individuals failing to perform 
their whole duty, from fear or any other cause, will not 
be retained in either of these stations. 
5 



42 DUTIES OE THE SEAMSTRESS. 



DUTIES OF THE SEAMSTRESS. 

The seamstress of the North Wing, under the direction 
of the matron, will take charge of all the men's clothing 
— keep it in good repair — see that it is not unnecessarily 
mislaid or lost, and that it is properly arranged for use. 

She will see that all clothing is marked before it is 
sent to wash, and whenever she finds that articles are 
missing, she must endeavor to ascertain what has become 
of them. 

Clothing that requires repairs will be taken to the 
clothes-room, each day, by the attendants of the North 
Wing, and the earliest opportunity must be taken to have 
it put in order and returned to the wards. 

All reasonable requests of patients in reference to 
changes of clothing, &c, are as far as possible to be 
gratified. 

In the South Wing, the seamstress will attend to the 
making and repairing of clothes, as may be directed by 
the proper officer. 

She will take especial pains to induce the patients to 
occupy themselves, and to become interested in their 
employment. 

When required, she will assist in the care of the 
patients. 






DUTIES OF THE COACHMAN. 43 



DUTIES OF THE COACHMAN. 

The coachman will take charge of such vehicles and 
horses as may be directed by the physician, and will see 
that they are always in good order and ready for use. 

He will drive out with the patients at such hours and 
for such time as may be indicated by the physician, and 
will be careful that no accident occurs. 

He will report any impropriety that may occur during 
a ride. 

He will not stop at any house, nor transact business 
for any one, while out with the patients, unless he has 
first received permission or instructions to that effect from 
the proper officer. 



44 DUTIES OP THE CARPENTER. 



DUTIES OF THE CARPENTER. 

The carpenter has the immediate care of the carpenter 
shop, lumber yard, tools, and materials of all kinds, be- 
longing to that department of the institution, and is con- 
sidered responsible for their safety and economical use. 

He will not allow any one to make use of the tools or 
lumber, without the permission of the physician or stew- 
ard; and when tools are taken from the shop for any 
purpose, if not promptly returned, he will report the fact 
to one of these officers. 

He will prevent attendants, patients, or others from 
remaining in the shop, so as to interfere with the work- 
men, unless they have themselves been sent there to 
work. 

No materials are to be taken from the shop or yard 
by any one without permission from one of the officers. 



DUTIES OF THE GARDENER. 45 



DUTIES OF THE GARDENER. 

The gardener will have the care of the pleasure-grounds, 
gardens, and green-house, which, under the instructions 
of the physician, he will keep in good order, and will see 
that all persons who aid in the performance of the work 
on these parts of the premises do their duty faithfully 
and in a proper manner. 

He will take care of all implements used for these 
purposes, and see that they are carefully housed and taken 
charge of. 

He is to consult the physician in reference to the sale 
of such seeds or plants as may not be required for the 
purposes of the institution, and keep a correct list of all 
sales made by him, with the names of the purchasers and 
the prices attached, which are to be accounted for to the 
steward at stated periods. 

When wishing to be absent, he will apply to the phy- 
sician or steward for permission. 



5* 



46 DUTIES OF THE GATE-KEEPER. 



DUTIES OF THE GATE-KEEPER. 

The gate-keeper will remain in or about his lodge, 
and when he leaves it, except for a very temporary pur- 
pose, he will see that some one, selected by the physician 
or steward, supplies his place. 

He will see that the gates are kept closed, excepfrwhile 
some one is passing, and that they are so secured that 
patients shall not escape thereby; and he shall notice 
particularly that no improper persons enter the enclosure. 

He is to be polite and respectful to all persons, visitors 
and others, who have occasion to pass through the gate, 
or have business at the hospital. 

He is to admit no one, unless on business with one of 
the officers, before 10 o' clock A. M., after sunset, nor 
after 1 P. M. on Seventh-day (Saturday), nor at any 
hour on the Sabbath, without permission from the phy- 
sician. 

No one, unless visiting one of the officers, will be 
allowed to remain within the enclosure at night, nor after 
dark, without express permission from the physician, and 
all such cases are to be promptly reported. 

He will lock his gate at a quarter before 10 o'clock, 
previous to which hour all persons should be inside of the 
enclosure. All persons returning after that hour are to 






DUTIES OF THE GATE-KEEPER. 47 

be reported to the physician or steward, according to their 
position in the house. 

He will also report each morning to the physician or 
steward the names of any persons employed who may 
have been out during the night, and the hour of their 
return in the morning. 

He is to request patients and all others to avoid stand- 
ing in or about the gateway, and he will be careful to 
report all irregularities or improprieties of any kind that 
may come under his notice. 



All persons employed in any way on the premises, 
and not mentioned specially in these Rules, are expected 
nevertheless to conform to the general spirit of them in 
the performance of their various duties. 



48 ADMISSION OF VISITORS. 



ADMISSION OF VISITORS. 

The following rules for the admission of visitors are 
appended, that they may be familiar to all employed in 
the institution : — 

Visitors are not admitted before 10 o'clock A. M., after 
sunset, nor on the Sabbath. They are not admitted on 
the afternoon of Seventh-day (Saturday), unless on special 
business with the attending managers, or one of the offi- 
cers of the house. 

All parts of the hospital not occupied by patients may 
be shown and explained during the hours for the admis- 
sion of visitors. 

No visitor, unless in company with a manager, can be 
taken into the wards, without permission from the physi- 
cian to the hospital, or, in his absence, from the assistant 
physician ; and when visitors are allowed to enter the 
wards, they will always be accompanied by one of these 
officers, or by the steward or matron. 

Visitors are not to pass through the grounds or hospital, 
without special permission, and they are requested not to 
stand near the windows, or to converse with the patients 
from the outside of the building. 

As this hospital cannot be allowed to become a resort 
for idle curiosity, it is hoped that the friends of patients, 



ADMISSION OF VISITORS. 49 

and all others, will carefully avoid prolonging their visits 
unnecessarily. 

The pleasure railroad, and other contrivances for the 
amusement of the patients, are not to be used by visitors. 

It is expressly forbidden to furnish any inmate of this 
hospital with tobacco in any form ; or to deliver to, or 
receive from, a patient, any letter, parcel, or package, 
without the knowledge and approbation of the physician. 

Funds for the use of the patients are to be placed in 
the hands of the steward, to be used under the direction 
of the physician. 

Under ordinary circumstances, carriages are not to 
enter the enclosure. When for any purpose they have 
been taken to the centre building, they are never to be 
left standing there ; and drivers are always expected to 
remain with their vehicles outside of the gateway. 

When visitors so far forget what is due to the feelings 
of the afflicted and their friends as to make improper 
remarks to patients, or to institute indelicate inquiries, all 
persons will be careful to discountenance such a course of 
conduct, and abstain from mentioning the names of pa- 
tients, their peculiarities, or any other circumstances 
respecting them, a general knowledge of which might be 
painful to any persons connected with them. None of 
us would be willing to have our own friends, if laboring 
under insanity, exhibited to strangers, and we are bound 
in honor, as far as possible, to protect others from a like 
exposure. 

No visitors, unless friends of the officers, are to remain 
inside of the enclosure after dark without special permis- 
sion. 



50 CONCLUSION. 



CONCLUSION. 

This code of rules has been prepared, as has been 
before remarked, for the purpose of enabling all connected 
with the Pennsylvania Hospital for the Insane to know 
the principles upon which it is wished it should be 
managed, and that they may so conduct themselves as 
most effectually to advance the best interests of the insti- 
tution, promote the restoration and happiness of its 
patients, and, it is believed, contribute to their own com- 
fort and satisfaction. 

It is hoped that none will ever engage in any of these 
situations who do not resolve to do all in their power to 
perform their prescribed duties to the best of their abili- 
ties, and who cannot show by their deeds that they have 
higher motives to actuate them than simply whatever 
pecuniary compensation it may be in the power of the 
institution to give them for their services. 

It is the wish, too, of the friends of this institution, 
that those engaged in all of its departments should be 
of such a character as to have only to know what is right 
and proper to secure its prompt and cheerful performance. 
Such individuals are sure to receive, and, what is still 
better, to deserve the respect and good wishes of the 
benevolent, and the grateful thanks of those who have 
been under their care. 



CONCLUSION. 51 

To enable all, by frequent reference, to become familiar 
with the foregoing rules and regulations, each person re- 
ferred to will be furnished with a copy when entering upon 
his or her duties. Each attendant's copy is to be sent 
to the physician's office, with the medicine trays, every 
Seventh-day (Saturday) evening, and a memorandum of 
its having been received will be made in it by the assistant 
physician before it is returned to its owner. It is expected 
that all engaged in any way in the care of the patients 
will read these rules carefully, and sufficiently often to 
make themselves familiar with them, as ignorance of their 
details cannot be admitted as an excuse for their not being 
observed. 



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